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Therapy Contamination as a Measure of Therapist Treatment Adherence in a Trial of Cognitive Behaviour Therapy versus Befriending for Psychosis

Published online by Cambridge University Press:  29 October 2013

Sarah Bendall ,
Kelly Allott ,
Martina Jovev ,
Marie-Josee Marois ,
Eoin J. Killackey ,
John F. Gleeson ,
Mario Alvarez-Jimenez ,
Patrick D. McGorry  and
Henry J. Jackson
Sarah Bendall*
Affiliation:
Orygen Youth Health Research Centre, andUniversity of Melbourne, Australia
Kelly Allott
Affiliation:
Orygen Youth Health Research Centre, andUniversity of Melbourne, Australia
Martina Jovev
Affiliation:
Orygen Youth Health Research Centre, andUniversity of Melbourne, Australia
Marie-Josee Marois
Affiliation:
Centre Hospitalier Universitaire de Quebec, Canada
Eoin J. Killackey
Affiliation:
Orygen Youth Health Research Centre, andUniversity of Melbourne, Australia
John F. Gleeson
Affiliation:
Australian Catholic University, Melbourne, Australia
Mario Alvarez-Jimenez
Affiliation:
Orygen Youth Health Research Centre, andUniversity of Melbourne, Australia
Patrick D. McGorry
Affiliation:
Orygen Youth Health Research Centre, andUniversity of Melbourne, Australia
Henry J. Jackson
Affiliation:
University of Melbourne, Australia
*
Reprint requests to Sarah Bendall, Orygen Youth Health Research Centre, Locked Bag 10, Parkville, Victoria, Australia3052. E-mail: sbendall@unimelb.edu.au
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Abstract

Background: High quality randomized controlled trials (RCT) of psychotherapeutic interventions should ensure that the therapy being tested is what is actually delivered. However, contamination of one therapy into the other, a critical component of treatment adherence, is seldom measured in psychotherapy trials of psychosis. Aims: The aim of the study was to determine whether a purpose-designed measure, the ACE Treatment Integrity Measure (ATIM) could detect therapy contaminations within a controlled trial of cognitive behavioural therapy (CBT) versus Befriending for first-episode psychosis and to compare the ATIM to a more traditional adherence measure, the Cognitive Therapy Scale (CTS). Method: Therapy sessions were audio-recorded and at least one therapy session from 53 of the 62 participants in the RCT was rated by an independent rater using the CTS and ATIM. Results: Ninety-nine therapy sessions were rated. All Befriending sessions and all but three CBT sessions were correctly identified. The ATIM showed that 29 of the 99 (29%) sessions were contaminated by techniques from the other therapy. Within the CBT sessions, 19 of the 51 sessions (37%) were contaminated by one or more Befriending techniques. Of the Befriending sessions, 10 of 48 (21%) were contaminated by ACE techniques. The mean CTS score was higher in the CBT than the Befriending group. Conclusions: The ATIM was able to detect contaminations and revealed more meaningful, fine-grained analysis of what therapy techniques were being delivered and what contaminations occurred. The study highlights the benefit of employing purpose-designed measures that include contamination when assessing treatment adherence.

Keywords

Treatment adherencetreatment fidelitycognitive behavioural therapyfirst episode psychosiscontamination
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 43 , Issue 3 , May 2015 , pp. 314 - 327
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2013 

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